Breastfeeding Medicine

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Worldwide study on sudden infant death finds factors associated with poverty and racism are more important than bedsharing

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Last week, we published our novel study, “Sudden Infant Death and Social Justice: A Syndemics Approach,” showing that bedsharing – which has been the main focus of many interventions – is not the primary risk behind sudden infant death.

Instead, factors associated with poverty and racism have much more to do with Sudden Unexplained Infant Death (SUID), which includes suffocation, and its subset, SIDS (Sudden Infant Death Syndrome). Looking at populations around the world and the known risk factors for sudden infant death, we found that the vast majority of infants dying are from poor or marginalized populations, especially people who have experienced historical trauma. On the other hand, many wealthy and privileged populations have high rates to moderate rates of bedsharing,like Asian Americans and Swedes, yet have some of the lowest rates of SUID/SIDS in the world.

We used the medical anthropological theory of syndemics to help explain how social inequities that may be driven by historical forces and their legacies lead to the clustering of these risk factors, which ultimately results in higher death rates in poor and marginalized populations. It is important to view SUID/SIDS in the greater context of the growing field of social determinants of health.

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Written by Melissa Bartick, MD, MSc, FABM

August 27, 2018 at 4:10 pm

Posted in Uncategorized

The well-being of mothers and children is not a tradeable commodity

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Breastfeeding is the foundation of public health and economic development. All major medical organizations recommend 6 months of exclusive breastfeeding, followed by continued breastfeeding through the first one to two years of life and beyond.

Evidence continues to mount that disrupting optimal breastfeeding contributes to disease burden and premature death for women and children. Globally, optimal breastfeeding would prevent 823,000 child deaths each year. In the US, enabling optimal breastfeeding would prevent 721 child deaths and 2619 maternal deaths each year, as well as 600,000 ear infections, 2.6 million gastrointestinal illnesses, 5,000 cases of maternal breast cancer and more than 8,000 heart attacks.

Optimal infant feeding is also essential for economic development. Being breastfed is associated with a 3 to 4 point increase in IQ, leading to better school performance and workplace productivity. As stated by the World Bank’s Keith Hansen, “If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.”

Breastfeeding is vital and essential to protect the world’s children, the most vulnerable who cannot speak for themselves.  Given the essential role of breastfeeding in global health and wellbeing, it is imperative that every nation supports policies and programs that enable women and children to breastfeed. It is therefore deeply troubling that the United States delegation to the World Health Assembly actively undermined efforts to enable optimal breastfeeding, as reported by the New York Times. Read the rest of this entry »

Written by bfmed

July 12, 2018 at 6:43 am

Separation of children and infants from parents – breastfeeding implications

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June 21, 2018 – The Academy of Breastfeeding Medicine, an international physician’s organization, condemns policies that result in the separation of parents from their children.

As the UN High Commissioner of Human Rights has established, “Children have the right to life, survival and development and to the highest attainable standard of health, of which breastfeeding must be considered an integral component.” Mothers similarly have the right to nurture their children: “Restriction of women’s autonomy in making decisions about their own lives leads to violation of women’s rights to health and, infringes women’s dignity and bodily integrity.”

“Separating children from their parents results in toxic stress that impacts breastfeeding and health for a lifetime,” said Timothy Tobolic MD, President of the Academy of Breastfeeding Medicine. “Furthermore, separating a mother from her breastfeeding child violates the human rights of both mother and child.”

Separation of the breastfeeding mother-baby pair further confers risk of acute illness for mother and child. Breastfeeding women who are separated from their infants and unable to drain their breasts will become engorged and are at risk for mastitis and breast abscesses. Unrelieved engorgement will precipitate involution and loss of milk supply.

Infants who are not breastfed face increased risks of ear infections, gastroenteritis and pneumonia. Separation of any infant from their mother also has untold emotional harms on those children. These risks are magnified if they are housed in facilities where proper preparation of formula or washing bottles and teats is not available.

Indeed, in emergency settings, such as refugee camps for migrant populations fleeing oppression, the first principal of the 2017 Operational Guidance for Infant and Young Child Feeding in Emergencies is the protection, promotion and support of breastfeeding. Separating a mother from her breastfed child violates this first principal.

ABM recommends reuniting infants and children with there parents without delay. When mother and child are reunited, the Academy of Breastfeeding Medicine and IYCFE guidelines recommend individual-level assessment by a qualified health or nutrition professional trained in breastfeeding and infant feeding issues. The mother-child pair will need sustained support to reestablish lactation, with access to an appropriate breast milk substitute until the mother’s milk supply is reestablished or until at least six months of age and beyond.

“We agree with President Trump’s executive order to stop the separation of infants and children from their parents.” said Dr. Tobolic. “Families belong together and breastfeeding must be supported for the health of the children.”

Written by bfmed

June 21, 2018 at 1:31 pm

Posted in Uncategorized

Breastfeeding Mitigates a Disaster

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Holocaust Memorial day, or as it is called in Israel and worldwide  as “Yom Hashoah”,  is combination of the most depressing sadness as we  of memorialize the 6,000,000 murdered victims  of Nazi Germany and their European collaborators, and  paradoxically, a celebration  of those individuals who somehow survived the horrors of mass murder and ethnic cleansing. The realization that 1.5 million infants and children were singled out  for elimination by the Nazi so as to prevent the chances  of a historical continuity of the European Jewish community is somehow counterbalanced by the miraculous stories of infants surviving, especially in the most unlikely circumstances and conditions.

This  past Yom Hashoah I had the opportunity to  view a documentary entitled “Geboren in KZ” (“Born in a Concentration Camp”, a film  by Eva Gruberova and Martina Gawaz for GDR Television )  which recounts the unbelievable story of 7 infants who were born in 1945 in  the Dachau, Germany  concentration camp. The fact that the mothers of these infants were able to conceal their pregnancies and reach term without being detected in of itself  defies comprehension, for as we know the policy of the Nazis was to send any women diagnosed as pregnant directly to the crematorium. Some of the women  even escaped  detection and “selection” for death  by the infamous Dr. Mengele in Auschwitz before being transferred to Dachau  No less  miraculous so was their ability to maintain a  minimal degree of nutrition to sustain their pregnancy till term or near term. Read the rest of this entry »

Written by aeidelmanmd

April 12, 2018 at 5:22 am

Posted in Uncategorized

ABM Ethics Committee Formal Grievance Review is Ongoing

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November 9, 2017 – The Academy of Breastfeeding Medicine has a formal process in place to address any member grievances, including potential conflict of interests. These routine procedures are outlined in our bylaws and our Code of Ethics. Both documents are available to all with no restricted access at www.bfmed.org.

Last week, the grievance review process was activated. Today, the Board of Directors discussed this ongoing matter in person at the regularly scheduled board meeting.

The Ethics Committee is actively reviewing ABM’s Conflict of Interest policies. The results of this policy review and any recommendations will be shared with membership following the January meeting of Board.

 

 

Written by bfmed

November 9, 2017 at 7:45 pm

Posted in ethics, Uncategorized

A tribute to Audrey Naylor

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As the ABM Founders Representative to the ABM Board, I wish to reflect on the personal and professional impact of one of our ABM Founders, Audrey Naylor, DrPH, MPH, MD, who recently passed away (6/23/2016).  Her personality and actions provided an example for all of us to be successful contributors to lactation management and the future success of the ABM. Audrey, as early as the late ‘70’s, recognized the “cascade” effect of training and teaching the teachers, i.e. she was a cofounder and CEO of Wellstart International. An example of her success with Wellstart is the internet breastfeeding training modules which are free online at www.wellstart.org . She focused, as each of us must do now, on educating learners to pass their knowledge on to the next generation of providers. Her model for education recognized that optimal breastfeeding management requires a coordinated multidisciplinary team; physicians practicing alone cannot be successful. This passion was brought to focus in her role as an early and prominent proponent of the Baby Friendly initiative. Audrey believed passionately in the world community. Her voice and passion about breastfeeding has been heard and recognized at UNICEF and the WHO. As a Founder of the ABM, Audrey was a very active proponent for the ABM to be an international organization. While her advocacy has been largely successful, we must continue to act as an international organization and create better ways for us to utilize the unique strengths of every culture/country.

Lastly, Audrey Naylor had the courage, strength of personality, academic credibility, and national/international reputation to be a vocal and active “Champion” of breastfeeding on the national and international stage. While few of us will attain her stellar level of recognition and achievement, each member of the ABM needs to be a vocal and active “Champion” for breastfeeding within our smaller communities. We need to be agents for constructive and positive change, as Audrey always was.

Audrey, thank you for your example and your friendship. We will always remember your professional training and performances as “The Red Nosed Clown” at our annual meetings.

Edward Newton, MD

Ed Newton, MD, FABM is a maternal-fetal medicine sub specialist and a founder of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by newtoned

August 7, 2016 at 10:30 am

Posted in Uncategorized

“Lactivism” and breastfeeding backlash: A second look

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It’s become routine: a big anti-breastfeeding piece comes out in a major publication like the New York Times, or The Atlantic or Time. A mom complains how the benefits of breastfeeding are overrated, how breastfeeding is being forced on people, how moms are feeling shamed into breastfeeding or risk being bad mothers.

Let’s listen to these moms for a minute. Regardless of what we breastfeeding people are actually saying, this is what moms are hearing. We need to ask ourselves, why do they hear this message?

Here’s why: Moms experience the “lactivist.” To the uninitiated, the term “lactivist” equals zealot. Someone who believes that breastfeeding is the answer for every mom in every situation, someone who is inflexible, incapable of listening to a mom’s individual needs and desires.

Any woman who’s just had a baby would probably see a “lactivist” as The Enemy. Imaging yourself as that new mom. You are not thinking the “lactivist” is a savior in a white cape who’s going to defend you from evil hospitals who want to give your baby formula. She’s someone who’s going to push everyone out of the way and make you breastfeed, regardless of your own trials and tribulations, your pain, your exhaustion. She’d not there to help you. She’s there to advance her own agenda of world breastfeeding hegemony.

And, if a mom doesn’t actually encounter a self-described lactivist, she might see the effects. All it takes is a journalist-mom who hears one resentful nurse say “we’re not allowed to teach formula feeding,” and you’ve generated enough anger for a full page New York Times op-ed. This journalist then misrepresents the scientific evidence for the entire world to prove her point that the so-called “Breastfeeding Nazis” are out to get you, and it’s just not worth it, because breastfeeding’s not even all that good for your baby anyway.

We must be careful with our rhetoric, and treat every single mom with compassion and understanding. We must take care in how we train our staff and how that staff communicates to patients. Breastfeeding people all know that it’s required to teach moms how to formula feed, and staff must feel inside that this is valuable information for many moms.

It only takes one “lactivist” to piss off a journalist. You never know who might turn around and write that next full page op-ed for the New York Times.

So please, let’s stop using the word “lactivist.” Better yet, let’s replace zealotry with compassion and understanding, and meet every mom where she is. And if we see zealotry in our colleagues, let’s gently remind them that this may be how we got to that Time magazine cover and New York Times op-ed. That is the only way we will stop this negative press.

Melissa Bartick, MD, MSc is an internist at Cambridge Health Alliance and Assistant Professor at Harvard Medical School. 

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by Melissa Bartick, MD, MSc, FABM

October 21, 2015 at 1:15 pm

Posted in Uncategorized